The shrinking reality of “legal” abortion

Last updated: April 2026

As of April 2026, abortion protections exist in 31 states and the District of Columbia, yet access is dramatically shrinking because of federal funding cuts, hospital policies, and new national pressure on abortion pills.

Top 5 Things to Know

• Abortion remains legal/protected in 31 states and DC, yet access is tightening through funding freezes, hospital policies, and new pressure on medication abortion (both state and federal levels).
• Approximately 50 Planned Parenthood clinics closed in 2025 as a direct result of Medicaid cuts in 2025. The cuts affect all covered services, including contraception, STD testing, and breast exams - not just abortion. Eleven states moved to backfill the funding to keep clinics open: CA, CO, CT, IL, MA, ME, NJ, NM, NY, OR, WA.
• Lawsuits surrounding hospital policies, the federal Emergency Medical Treatment and Labor Act (EMTALA), and emergency reproductive care are actively navigating the court system, highlighting significant tensions between religious freedom claims and federal mandates to stabilize patients needing non-elective abortion procedures.
• Abortion pills face renewed national pressure that could affect access regardless of state law. This is on top of the states seeking to remove access to pills in their states - Florida, Oklahoma, Texas, South Dakota, and Mississippi.

Other things to watch: The rise of "crisis pregnancy centers" and an imminent Supreme Court decision on them, the federal government's plans to end Title X funding in 2027, and moving future funds away from contraceptives to conception-based family planning methods.

Why it Matters

In recent years, many barriers have come from how abortion care is delivered—through funding changes, hospital policies, and restrictions on medication abortion. New legislative and regulatory efforts are now also targeting the legal framework itself, particularly around abortion pills.

At the same time, changes to funding and policy around contraception may affect access to preventive care, limiting options that help people avoid unintended pregnancy in the first place.

Taken together, these shifts are creating a more constrained and interconnected landscape. Even in states where abortion is legal, people may face fewer options overall—both in preventing pregnancy and in accessing care—along with longer travel distances, delays, and limited provider availability.

Background

Mifepristone was approved by the FDA 25 years ago and offers a safe, accessible, and more private option to surgical abortion. According to the Guttmacher Institute, medication abortion accounted for 63% of all abortions provided in the US in 2023. The recent approval of a new generic version of mifepristone has caused outrage among anti-abortion groups. 

After Roe v. Wade was overturned in 2022, the Biden administration did two things to protect abortion access at the federal level and emergency reproductive care in anti-abortion states: First, it allowed patients to obtain the medication through the mail, without an in-person appointment. Second, it added clarifications to existing EMTALA legislation around emergency abortion procedures. President Trump rescinded the latter on May 29, 2025.

The Guttmacher Institute opinion piece linked below details the post-Dobbs landscape from the perspective of anti-abortion groups.

And finally, here is a summary of Project 2025 on abortion rights (sourced from MSI): 

• Limit access to abortion across the US
• Withdraw the FDA’s approval of mifepristone and remove it from the market
• Ban abortion pills, equipment, or materials from being sent through USPS
• Dismantle abortion protections under EMTALA
• Increase data collection on abortion and require all states to report all abortions that take place—states that don’t share abortion data will have federal funds withheld

Things to Know

• Title X: A federal grant program supporting family-planning and preventive health services.
• EMTALA: The Emergency Medical Treatment and Labor Act requires hospitals to stabilize patients in emergencies, regardless of ability to pay.
• Mifepristone: The first of two medications commonly used in medication abortion; approved by the FDA in 2000.
• USAID: This year, the Trump administration destroyed nearly $10 million worth of taxpayer-funded contraceptives, budgeted by the US Agency for International Development (USAID), and intended for low-income countries. 
• Mifepristone: The first of two medications commonly used in medication abortion; approved by the FDA in 2000.
• EMTALA: The Emergency Medical Treatment and Labor Act requires hospitals to stabilize patients in emergencies, regardless of ability to pay.

Resources

The Hill - Planned Parenthood drops challenge over Trump administration Medicaid cuts
WRDI - Congress and federal agencies turn attention to medication abortion
Politico - Trump admin moves Title X family planning program away from contraception, toward conception
Susan B Anthony Pro-Life America - Defunding Victories: The Full List of 2025 Planned Parenthood Closures
Abortion Everyday - The Catholic Hospital System Killing Women
AAMC - CMS Rescinds EMTALA Guidance on Hospital Obligation to Provide Emergency Abortions
LA Times - Emergency abortion denials by Catholic hospitals put woman in danger, lawsuit claims
Guttmacher Institute - Three Years Post-Roe: The Escalating Campaign to Make Abortion Inaccessible Nationwide (opinion)
PBS News - Rise of crisis pregnancy centers highlights shift in anti-abortion movement